Tag: Fibromyalgia

An in-depth guide on Fibromyalgia, covering its symptoms, causes, treatments, and tips for managing this chronic condition effectively.

  • Chronic vulvar pain related to irritable bowel syndrome, fibromyalgia and interstitial cystitis

    Chronic vulvar pain related to irritable bowel syndrome, fibromyalgia and interstitial cystitis

    Women with vulvodynia at much higher risk for other chronic pain conditions, according to a new University of Michigan Health System study.

    Millions of women suffer from unexplained vulvar pain so severe it can make intercourse, exercise and even sitting unbearable.

    New research now shows that women with this painful vaginal condition known as vulvodynia are two to three times more likely to also have one or more other chronic pain conditions, including irritable bowel syndrome, fibromyalgia (musculoskeletal pain) and interstitial cystitis (bladder pain).

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    These increasingly prevalent chronic pain conditions are known to be underdiagnosed — and the new data sheds more light on how they may also be related, according the University of Michigan Health System study that was published in Obstetrics & Gynecology.

    “Millions of people in the U.S. have chronic pain. This report stresses the need to further study relationships between these types of disorders to help understand common patterns and shared features,” says lead author Barbara D. Reed, M.D., M.S.P.H., professor of family medicine at the U-M Medical School.

    “Chronic pain conditions like these can seriously hamper quality of life and it’s imperative that we understand the commonality among them. Results we see in any studies related to one of the conditions, such as regarding etiology, physiology, or treatment, may be relevant to any of others.”

    Other studies show that chronic pain conditions are much more prevalent than previously estimated, and there has been growing interest in understanding the patterns of co-occurrence, Reed says.

    “Women who have these disorders often see physicians but are not given a diagnosis or are given an erroneous diagnosis and continue to suffer without being treated properly,” Reed says. “Until their symptoms have a name, it can be really discouraging because patients begin thinking it’s all in their head.

    “Chronic pain is starting to get a lot more attention, with more research being done on all of these disorders, as well as combinations of these disorders. I think the identification and treatment of these conditions will continue to improve.”

    Authors used data from the six-month follow-up survey of the Michigan Woman to Woman study, a population-based cohort of 2,500 adult women in southeast Michigan. An original study found that more than 25 percent of surveyed women in the metro Detroit area have experienced ongoing vulvar pain at some point in their lives but only 2 percent ever sought treatment for their pain.

    Additional Authors: Besides Reed, authors include Siobán D. Harlow, Ph.D., Ananda Sen, Ph.D., Rayna M. Edwards, MPH, Di Chen, MPH, and Hope K. Haefner, M.D.

    Funding: National Institute of Child Health and Human Development, of the National Institute of Health

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  • Role of impaired sleep in fibromyalgia pain explored

    Role of impaired sleep in fibromyalgia pain explored

    Patients coping with the complex pain disorder fibromyalgia often have difficulty sleeping, and a new study published in The Journal of Pain reports that despite the negative quality of life implications, poor sleep is not a significant predictor of fibromyalgia pain intensity and duration.

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    The complexity of fibromyalgia as a pain disorder is rooted in the variable, patient-to-patient, influence of physical, psychological, social factors that contribute to clinical pain, and their influence often is difficult to understand. Previous research has shown that variables such as negative mood and the number of localized pain areas are significant predictors of clinical pain in fibromyalgia patients.

    Many fibromyalgia patients complain about poor sleep, and studies have shown that interrupted sleep experienced by individuals with other pain conditions is predictive of next day clinical pain. Also, sleep duration has been shown to predict clinical pain in healthy adults. For this study, a research team from the University of Florida hypothesized that decreased total sleep time would predict higher clinical pain in a sample of patients with fibromyalgia.

    Seventy-four adults with fibromyalgia were recruited for a University of Florida study and they were observed for 14 days. Subjects rated their clinical pain every evening and completed sleep diaries describing the previous night’s sleep.

    Results of the analysis showed that four sleep measures evaluated in the study failed to significantly predict clinical pain. The authors noted that the effects of impaired sleep, such as fatigue and inactivity, may play more significant roles in clinical pain than measures of sleep duration or insomnia.

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  • Psychological intervention reduces disability and depression in adolescents with fibromyalgia

    Psychological intervention reduces disability and depression in adolescents with fibromyalgia

    A recent trial shows cognitive-behavioral therapy (CBT) reduces functional disability and depressive symptoms in adolescents with juvenile fibromyalgia. The psychological intervention was found to be safe and effective, and proved to be superior to disease management education. Full findings from this multi-site clinical trial are published in Arthritis & Rheumatism, a peer-reviewed journal of the American College of Rheumatology (ACR).

    Medical evidence reports that juvenile fibromyalgia syndrome affects 2% to 7% of school age children. Similar to adult cases, the juvenile form of the disorder primarily strikes adolescent girls. Both adult and juvenile fibromyalgia patients experience widespread musculoskeletal pain, fatigue, as well as sleep and mood disturbances. Previous studies show that juvenile fibromyalgia patients are burdened with substantial physical, school, social and emotional impairments. However, studies investing treatment for the juvenile form of the disorder are limited.

    For the current trial, led by Dr. Susmita Kashikar-Zuck from the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center in Ohio, investigators recruited 114 adolescents between the ages of 11 and 18 years who were diagnosed with juvenile fibromyalgia. The trial was conducted at four pediatric rheumatology centers between December 2005 through 2009, with participants randomized to cognitive-behavioral therapy or fibromyalgia education, receiving eight weekly individual therapy sessions and two additional sessions in the six months following the end of active therapy.

    Analyses showed that both patient groups displayed significant reduction in functional disability, pain, and depressive symptoms at the end of the trial. Pediatric participants in the cognitive-behavioral therapy group reported a significantly greater reduction in functional disability compared to those receiving fibromyalgia education. The therapy group had a 37% improvement in disability compared to 12% in the education cohort. Both groups had scores in the non-depressed range by the end of the study, but pain reduction was not clinically significant — a decrease in pain of less than 30% for either group.

    The drop-out rate was low with over 85% of participants attending all therapy sessions and no study-related adverse events were reported by investigators. “Our trial confirms that cognitive-behavioral therapy is a safe and effective treatment for reducing functional disability and depression in patients with juvenile fibromyalgia,” concludes Dr. Kashikar-Zuck. “When added to standard medical care, cognitive-behavioral therapy helps to improve daily functioning and overall wellbeing for adolescents with fibromyalgia.”

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  • Immediate treatment can alleviate future back problems, research suggests

    Immediate treatment can alleviate future back problems, research suggests

    Immediate treatment by a physiotherapist, bypassing a waiting list, can reduce problems with recurring low back pain, reveals a thesis from the University of Gothenburg, Sweden.

    Many people suffer with low back pain, and most get better. However, those who suffer with long-term pain can find that their work, everyday and leisure activities are limited to varying degrees. Given that long-term pain often requires extensive treatment, it is important that the pain be treated at an early stage.

    “I wanted to find out whether patients’ low back pain could be alleviated in the long run if primary care clinics could offer examinations and treatment by a physiotherapist without any delay in the form of a doctor’s referral or waiting list,” says Lena Nordeman, a registered physiotherapist and researcher at the Sahlgrenska Academy.

    As part of her thesis, she therefore carried out a study in a same-day appointment model with the option of going straight to a physiotherapist, with or without a referral from a doctor. The effect of receiving an examination and treatment within 48 hours was subsequently evaluated compared to being on a waiting list for four weeks before receiving the same treatment.

    60 patients with low back pain for 3-12 weeks took part in the study, which was carried out in primary health care in Södra Älvsborg, south-west Sweden.

    “We saw that both groups improved after the treatment ended. The group that had been given early access to an examination and individualised treatment maintained their improvement after six months, while the group that had been held on a waiting list were more likely to suffer with recurring back pain,” says Nordeman, who draws the conclusion that early examination and treatment by a physiotherapist as soon as a patient asks for care could be important for reducing low back pain in the long term.

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    Her thesis also included an investigation of 130 women who had suffered with low back pain for more than three months and who among others had undertaken a walk test. A follow-up after two years revealed that the walk test was a good predictor of both future ability to work and limitations in everyday activities.

    It is recommended that patients with long-term widespread pain or fibromyalgia be given education and a physical exercise programme to help alleviate their symptoms. Nordeman’s thesis also looked at which patients benefit most from this treatment. 166 patients with widespread pain or fibromyalgia from Gothenburg, Uddevalla and Alingsås were randomly divided into two groups, the first of which was given a six-session education programme and 20-week pool exercise programme supervised by a physiotherapist, while the second was given just the education programme.

    “We saw that the group that received both the education and the physical exercise programme showed the greatest improvement in perceived health, and that patients with moderate symptoms benefitted most from exercise,” says Nordeman.

    Low back pain

    Low back pain affects up to 80% of people of working age at some time in their lives, though most will recover. Low back pain can be recurring, and some people will continue to suffer with some degree of pain. In 85-90% of cases the pain cannot be attributed to a specific illness or injury.

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  • Study probes obesity link to fibromyalgia

    Study probes obesity link to fibromyalgia

    Afflicting up to 5 percent of the U.S. population, mostly women, fibromyalgia is characterized by widespread pain and range of function problems. A new study in The Journal of Pain reports there is close association between obesity and disability in fibromyalgia patients.

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    The purpose of the study, conducted by University of Utah researchers, was to evaluate the relationship between fibromyalgia and obesity. They hypothesized that obesity significantly adds to the disease and disability burden of the condition. Two hundred fifteen fibromyalgia patients were evaluated in the study and given several physical tests to measure strength, flexibility, range of motion, and strength. Heart rates and sleep quality also were assessed.

    The authors reported that consistent with previous studies, obesity is common among those with fibromyalgia. Half the study sample was obese and an additional thirty percent were overweight. Also consistent with previous findings, obese patients in this study showed increased pain sensitivity, which was more pronounced in lower body areas. The obese patients also had impaired flexibility in the lower body and reduced strength.

    The study concluded that obesity is a common comorbidity of fibromyalgia that may compromise clinical outcomes. The adverse impact of obesity is evidenced by hyperalgesia, disability, impaired quality of life and sleep problems. The authors also noted that recent evidence suggests weight loss improves fibromyalgia symptoms, perhaps resulting from patients adopting healthier lifestyles and taking more positive attitudes toward symptom management, and overall quality of life.

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  • High rate of restless legs syndrome found in adults with fibromyalgia

    High rate of restless legs syndrome found in adults with fibromyalgia

    A study in the Oct. 15 issue of the Journal of Clinical Sleep Medicine found that adults with fibromyalgia had a much higher prevalence and risk of restless legs syndrome than healthy controls. The study suggests that treating RLS may improve sleep and quality of life in people with fibromyalgia.

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    Results show that the prevalence of restless legs syndrome was about 10 times higher in the fibromyalgia group (33 percent) than among controls (3.1 percent). After statistical adjustments for potential confounders such as age, gender and ethnicity, participants with fibromyalgia were 11 times more likely than controls to have RLS (odds ratio = 11.2). As expected, considerable sleep disruption was reported by participants with fibromyalgia using the Pittsburgh Sleep Quality Index, Insomnia Severity Index and Epworth Sleepiness Scale. In the fibromyalgia group these sleep problems were more severe among people who also had RLS.

    “Sleep disruption is common in fibromyalgia, and often difficult to treat,” said contributing author Dr. Nathaniel F. Watson, associate professor of neurology at the University of Washington in Seattle, Wash. “It is apparent from our study that a substantial portion of sleep disruption in fibromyalgia is due to restless legs syndrome.”

    The research team led by Dr. Watson and lead author Dr. Mari Viola-Saltzman of Loyola University Medical Center in Maywood, Ill., studied 172 people with fibromyalgia who had a mean age of 50 years; 93 percent were female. They were compared with 63 healthy controls who had a mean age of 41 years.

    Fibromyalgia was identified by self-report or review of the medical records, and it was confirmed on examination according to published guidelines regarding the presence of pain that is chronic and widespread pain . Pain was assessed by subjective report and by objective measurement with a dolorimeter, a spring-loaded gauge that is used to apply standardized rates of pressure to tender points on the arms and legs.

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    According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, fibromyalgia can cause significant pain and fatigue. It is estimated to affect 5 million Americans age 18 or older, and between 80 and 90 percent of those diagnosed with fibromyalgia are women. The causes of fibromyalgia remain unknown.

    Restless legs syndrome was diagnosed using a self-administered, validated questionnaire. RLS is a sleep-related movement disorder that involves an urge to move the legs that is usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. This urge begins or worsens during periods of rest or inactivity, is partially or totally resolved by movement, and worsens or only occurs at night. RLS occurs 1.5 to two times more commonly in women than in men.

    Watson noted that treating restless legs syndrome may be one of the keys to reducing fatigue and improving quality of life in people with fibromyalgia. RLS often can be successfully treated with a medication such as pramipexole or ropinirole.

    “Since restless legs syndrome is a treatable condition, diagnosing and treating RLS in fibromyalgia patients has the potential to improve their sleep,” Watson said.

    According to the authors, the cross-sectional nature of the study did not allow for an examination of causality. However, several aspects of the two syndromes suggest a logical overlap. Both disorders involve sensory abnormalities, and a similar pathophysiology of the system that regulates the neurotransmitter dopamine has been proposed for both syndromes. Furthermore, restless legs syndrome may be induced by antidepressants, which are a common treatment for pain and depression in fibromyalgia. Also, exercise has been shown to improve the symptoms of both syndromes.

    The study was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health and by the National Fibromyalgia Research Association.

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  • Adolescents with fibromyalgia who are physically active report lower levels of pain and disability

    Adolescents with fibromyalgia who are physically active report lower levels of pain and disability

    Adolescents with fibromyalgia who are physically active report lower levels of pain and disability, according to findings of a multicenter study published in The Journal of Pain, published by the American Pain Society.

    Led by researchers at Cincinnati Children’s Hospital, this study is the first to use actigraphy-based physical activity monitoring to measure the relationship of pain, perceived functional impairment and depressive symptoms in adolescents with juvenile primary fibromyalgia syndrome (JPFS). For the research, 104 adolescents ages 11-18 were fitted with hip-mounted actigraphs for one week. The battery-powered device measures the amount and intensity of human physical activity.

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    The research objectives were to measure physical activity levels in adolescents with JPFS, examine differences and characteristics of high and low activity subjects, and explore the impact of psychiatric disorders on physical activity. The objective activity measurements were intended to address concerns about the reliability of self reports on the impact of pain on physical activity, and validate observations that some JPFS patients remain vigorously active while enduring significant pain.

    Results showed that adolescents with JPFS did not engage in physical activities and aerobic exercise at levels recommended by their physicians. Just 23 percent of the subjects participated in 30 minutes of daily moderate-to-vigorous physical exercise, and only one adolescent engaged in 60 minutes of exercise every day. Low levels of exercise in these patients are troubling to clinicians who view exercise as a major component for improved pain management.

    Another key finding was that higher pain intensity ratings were not significantly associated with lower levels of activity in the group as a whole. The authors noted that adolescents with JPFS have other symptoms that may diminish interest in physical activity, such as fatigue and impaired sleep. The authors also noted that higher pain levels in the least active group may be related to their decreased activity or vice versa.

    Further, the inactive group had higher levels of depressive symptoms and functional disability, according to parent reports. However, in the small number of JPFS patients who maintained very high levels of physical exercise, the reported pain levels were lower than the inactive group, perhaps due to exercising, and their parents reported they had lower depressive symptoms and disability than inactive subjects.

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  • How badly does it hurt? Research examines the biomedical diagnosis of pain

    How badly does it hurt? Research examines the biomedical diagnosis of pain

    Is the science of diagnosing pain causing a number of pain sufferers to defend their honor? Research out of the University of Cincinnati is examining the diagnosis of pain that evades scientific testing, and the additional emotional suffering that can result for the patient.

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    The research by Elizabeth Sweeney, a doctoral candidate in UC’s Department of Sociology, was presented August 16 at the 105th annual meeting of the American Sociological Association in Atlanta. The paper, “Defining Reality: How Biomedical Researchers Determine the Existence of Pain,” analyzed more than 20 articles randomly selected from the peer-reviewed international academic journal PAIN®, the official publication of the International Association for the Study of Pain.

    Sweeney examined the journal’s content to determine how pain is measured and defined in terms of type of pain, location of pain, its causes, severity, duration, response to treatment, methods of detection and symptoms. Because of these evidence-based diagnostic tests, the paper states that sufferers of chronic pain — conditions that frequently cannot be localized or pointed out on a scan or test — are often put in the position of defending the legitimacy or the reality of their condition.

    Examples of these chronic pain sufferers of unexplained or “contested” illnesses can include patients with Chronic Fatigue Syndrome, Complex Regional Pain Syndrome (CRPS), fibromyalgia and Gulf War Syndrome.

    “It is apparent from this research that the missing link in much of biomedical research is any viable attempt to understand the subjective experience of pain,” Sweeney writes.

    “A diagnosis, simple though it may seem, constitutes not only the legitimacy of one’s illness, but also the validation of one’s sanity and honor — evidence that the patient is not psychologically unstable and is not ‘faking’ it,” says Sweeney.

    The paper details that the journal, PAIN®, which for more than 30 years has focused on the study and research of pain, is considered one of the world’s premiere sources of biomedical research on pain. The articles that were analyzed were published between May 2008 and May 2009.

    Demonstrating the challenges that pain and chronic pain pose to Western medicine, Sweeney concludes that deconstructing biomedical research on pain will better pave pathways of understanding in diagnosing and treating chronic pain sufferers.

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  • New principle discovered for how muscle pain is signaled

    New principle discovered for how muscle pain is signaled

    Chronic muscular pain may be linked to a previously unknown principle for how pain signals are transmitted in the human body.

    This is shown by Umeå University researchers Tuija Athanassiadis and Karl-Gunnar Westberg, in collaboration with Canadian associates, in the scientific journal PLoS ONE.

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    Muscles have sensory organs called muscle spindles. Their task is to inform the brain of changes in muscle length. Muscle spindles therefore contain a special type of large diameter nerve filaments that signal stretch of the muscle. The Umeå scientists’ studies show that muscle spindles also contain fine nerve filaments with pain receptors. When a muscle is damaged as a result of overloading, these pain receptors are activated by the release of a signal substance from the neighboring stretch-sensitive nerve filaments in the muscle spindle.

    It was previously believed that the pain receptors in muscles were exclusively found in the membranes that surround the muscles or in connection with the blood vessels in the muscle. With these new findings the Umeå researchers are drawing attention to a hitherto unknown and interesting mechanism. Damage to the stretch-sensitive nerve filaments of the muscle spindle may contribute to and sustain chronic pain in jaw muscles as well as in other muscles.

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  • Biological Link Between Pain And Fatigue Discovered

    Biological Link Between Pain And Fatigue Discovered

    A recent University of Iowa study reveals a biological link between pain and fatigue and may help explain why more women than men are diagnosed with chronic pain and fatigue conditions like fibromyalgia and chronic fatigue syndrome.

    Working with mice, the researchers, led by Kathleen Sluka, Ph.D., professor in the Graduate Program in Physical Therapy and Rehabilitation Science in the UI Roy J. and Lucille A. Carver College of Medicine, found that a protein involved in muscle pain works in conjunction with the male hormone testosterone to protect against muscle fatigue.

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    Chronic pain and fatigue often occur together — as many as three in four people with chronic, widespread musculoskeletal pain report having fatigue; and as many as 94 percent of people with chronic fatigue syndromes report muscle pain. Women make up the majority of patients with these conditions.

    To probe the link between pain and fatigue and the influence of sex, the UI team compared exercise-induced muscle fatigue in male and female mice with and without ASIC3 — an acid-activated ion channel protein that the team has shown to be involved in musculoskeletal pain.

    A task involving three one-hour runs produced different levels of fatigue in the different groups of mice as measured by the temporary loss of muscle strength caused by the exercise.

    Male mice with ASIC3 were less fatigued by the task than female mice. However, male mice without the ASIC3 protein showed levels of fatigue that were similar to the female mice and were greater than for the normal males.

    In addition, when female mice with ASIC3 were given testosterone, their muscles became as resistant to fatigue as the normal male mice. In contrast, the muscle strength of female mice without the protein was not boosted by testosterone.

    “The differences in fatigue between males and females depends on both the presence of testosterone and the activation of ASIC3 channels, which suggests that they are interacting somehow to protect against fatigue,” Sluka said. “These differences may help explain some of the underlying differences we see in chronic pain conditions that include fatigue with respect to the predominance of women over men.”

    The study, which was published in the Feb. 28 issue of the American Journal of Physiology — Regulatory, Integrative and Comparative Physiology, indicates that muscle pain and fatigue are not independent conditions and may share a common pathway that is disrupted in chronic muscle pain conditions. The team plans to continue their studies and investigate whether pain enhances fatigue more in females than males.

    “Our long-term goal is to come up with better treatments for chronic musculoskeletal pain,” Sluka said. “But the fatigue that is typically associated with chronic, widespread pain is also a big clinical problem — it leaves people unable to work or engage in social activities. If we could find a way to reduce fatigue, we could really improve quality of life for these patients.”

    In addition to Sluka, the UI research team included Lynn Burnes, a research assistant and lead author of the study; Sandra Kolker; Jing Danielson; and Roxanne Walder. The study was funded in part by grants from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.

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